Patient Engagement Improves Healthcare Outcomes and Lowers Cost, New Studies Find

By Editor, on February 4th, 2013

Health Literacy by Patients is a Key to Improving Healthcare Outcomes and Lowering Costs, new studies find The February, 2013 issue of the journal HealthAffairs features several studies addressing how more active engagement of patients in their own health and health care can affect health care outcomes and costs of care.

“Studies show that more informed and empowered patients have better health outcomes, and there is some evidence that they also have lower health care costs,” according to a news release issued by HealthAffairs on February 4, summarizing some of the new studies and their findings.

University of Oregon Study finds that informed and engaged patients have lower health care costs

A featured study published in the February issue of HealthAffairs, by Judith Hibbard of the University of Oregon and coauthors, “found that patients with the lowest level of ‘activation’–that is, those most lacking in the skills and confidence to be actively engaged in their health care, had average costs that were from 8 percent to 21 percent higher compared to patients with the highest level of activation,” according to the journal’s news release. This finding held even after controlling for “the severity of patients’ health conditions, age, sex, and income,” the journal reported.

“The researchers recommend that health delivery systems consider assessing these patient activation scores and supporting patients to become more engaged in their health and health care, as a way to both improve patient outcomes and lower costs.”

HHS Reports on federal government initiatives to promote health literacy, and why health literacy is important

Another featured article, prepared by the U.S. Department of Health & Human Services (HHS), entitled “New Federal Policy Initiatives to Boost Health Literacy Can Help the Nation Move Beyond the Cycle of Costly ‘Crisis Care’,” outlines what HHS is doing to improve healthy literacy rates nationwide. Among the successes toward encouraging health literacy by Americans cited by HHS:

The healthcare reform law,
The National Action Plan to Improve Healthy Literacy, and
The Plain Writing Act of 2010.

According to a Quick Guide to Health Literacy published by HHS and containing fact sheets, strategies, and resources for health care providers, to help promote health literacy by patients,

“Only 12 percent of adults have Proficient health literacy, according to the National Assessment of Adult Literacy. In other words, nearly 9 out of 10 adults may lack the skills needed to manage their health and prevent disease. Fourteen percent of adults (30 million people) have Below Basic health literacy. These adults were more likely to report their health as poor (42 percent) and are more likely to lack health insurance (28 percent) than adults with Proficient health literacy. Low literacy has been linked to poor health outcomes such as higher rates of hospitalization and less frequent use of preventive services.”

According to HHS, studies have shown that persons with low health literacy are also:

more likely to skip important preventive measures such as mammograms, Pap smears, and flu shots,
more likely to have chronic conditions, such as high blood pressure, diabetes, or asthma, and less able to manage them effectively, and
more likely to have higher rates of hospitalization and use of emergency services,

than persons with the ability and knowledge to obtain, process, and understand health information needed to make informed health decisions (which HHS defines as “health literacy”).

“Choosing a healthy lifestyle, knowing how to seek medical care, and taking advantage of preventive measures require that people understand and use health information,” HHS states.

Health Affairs Explores Whether “Patient Activation and Engagement” Are Panaceas in February Issue

Emerging Evidence Shows Promise and Challenges of Approach to Care

Bethesda, MD — The February issue of Health Affairs explores the burgeoning field of activating and engaging patients in their health and health care. Studies show that more informed and empowered patients have better health outcomes, and there is some evidence that they also have lower health care costs.

The issue, which discusses the challenges and opportunities for engaging patients, was supported by the Robert Wood Johnson Foundation, the Gordon and Betty Moore Foundation, the Patient-Centered Outcomes Research Institute, and the California HealthCare Foundation. Another featured article in the issue reports on how offering online health care for patients with simple conditions saved money for a prominent Minnesota health plan.

Patients rated lowest in terms of their involvement with their care have substantially higher health costs than those rated more highly, at least in the short and medium term. A featured study by Judith Hibbard of the University of Oregon and coauthors found that patients with the lowest level of “activation”–that is, those most lacking in the skills and confidence to be actively engaged in their health care, had average costs that were from 8 percent to 21 percent higher compared to patients with the highest level of activation. Using the Patient Activation Measure that assesses beliefs, knowledge, and confidence in managing health-related tasks, the researchers found that patient scores on a questionnaire that ranks patient activation showed that patients’ responses in effect predicted their overall care costs, even when adjusted by the severity of patients’ health conditions, age, sex, and income. The researchers recommend that health delivery systems consider assessing these patient activation scores and supporting patients to become more engaged in their health and health care, as a way to both improve patient outcomes and lower costs.

Online health care for common conditions typically cared for by primary care providers has the potential to help meet the “Triple Aim” of better health, better health care, and lower costs–and lead to more satisfying customer and patient experiences. Patrick Courneya of HealthPartners in Minneapolis and colleagues report on the experience of HealthPartners’ online clinic, called “virtuwell.” Launched in 2010, virtuwell provides twenty-four-hour online access, diagnosis, and treatment (including prescriptions) by nurse practitioners for about forty simple conditions, such as sinus infections, urinary tract infections, and pink eye. The authors note that virtuwell is the first online service to be authorized for coverage under Medicare. After 40,000 cases of patients using online care, HealthPartners saw an average savings of $88 per episode over traditional care settings–plus evidence that the care was clinically effective, and that 98 percent of patients were willing to recommend the service. The authors caution that these findings may not apply to all online care models, but they recommend that policy makers examine various regulatory barriers that prevent expansion of these promising online practices.

Private and public sector leaders weigh in with their perspectives:

Ten Strategies To Lower Costs, Improve Quality, And Engage Patients: The View From Leading Health System CEOs, Delos Cosgrove of the Cleveland Clinic

The Best Way To Improve Outcomes Research: Engage The Patient, Rachael Fleurence of the Patient-Centered Outcomes Research Institute

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically and health policy briefs published twice monthly at www.healthaffairs.org. Read daily perspectives on Health Affairs Blog. Download monthly Narrative Matters podcasts on iTunes. Tap into Health Affairs content with the new iPad app.

More Information

The February, 2013 issue of HealthAffairs, entitled, “New Era Of Patient Engagement,” is available online from the journal HealthAffairs.

For more information on health literacy and what the federal government (HHS) is doing to promote health literacy by Americans, see the Health Literacy page of Health.gov, a site operated by the U.S. Department of Health & Human Services (HHS).

See also related HelpingYouCare^® reports on:

Improving Your Health Literacy May Help You Improve Your Health, Survey Suggests

New AHRQ Initiative: Questions are the Answer For Better Doctor-Patient Communication

Low Health Literacy Linked to Higher Death Rate Among Heart Patients

Americans Increasingly Find Health Information via Internet, CDC Reports

At What Ages Do Baby Boomers Show Increased Interest in Health?

NIH Announces New 52-Week Mobile Health App for Women

New High Value Care Guides for Patients Are Jointly Announced by American College of Physicians & Consumer Reports

Can a Patient Know Too Much? Are You Annoying Your Doctors?

At National Health IT Week Summit HHS Proposes New Rules to Give Patients Direct Access to Their Lab Reports

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